tbuckley/cabot-search huggingface dataset:
Abstract 14356: Machine Learning for Detection of Presence and Severity of Aortic Stenosis From B-mode Ultrasound Images: Results of a Blinded Clinical Trial
Authors: Nicolas Poilvert, Steven Goldstein, Roberto M Lang, Dermot Phelan, David Rubenson, Michele Temple-Wong, Yngvil Kloster Thomas, Randolph P Martin, James Thomas
Journal: Circulation (2022)

Introduction: Aortic stenosis (AS) is common, with &gt;= moderate severity ~10% above age 75. Despite new therapies, many with AS go undiagnosed due to lack of echo availability and untreated due to improper interpretation. To expand AS diagnosis, we developed an artificial intelligence (AI) algorithm to characterize AS from routine B-mode echo exams without Doppler (AutoAS). Methods: 80,000 de-identified clinical echoes were assembled spanning none, mild, moderate, and severe AS. About 30,000 of these were used to train a convolutional neural network (CNN) using labels derived from a cluster analysis of maximal jet velocity, mean AS gradient, and aortic valve area (AVA). Once labeled, we extracted all available B-mode clips from parasternal long-axis, short axis at aortic level, and apical 5-chamber views, irrespective of image quality. A spatiotemporal CNN was trained to return a probability distribution for none/mild/moderate/severe AS. To assess performance of the model, a hold-out test set of echoes uniformly distributed over patient sex and AS severity was used. Three Level 3 echo trained cardiologists blindly read the complete Doppler echoes and agreed to call AS severity by AVA (&lt; 1 cm2, severe; 1.0-1.5 cm2, moderate; &gt; 1.5 cm2 but restricted, mild; no restriction, none). Results were also dichotomized into none/mild and moderate/severe AS. Results: 40 cases comprised this initial test set. Consistency among the readers was outstanding, with κ = 0.95. The table shows the confusion matrix between AutoAS and panel reads, with excellent accuracy (κ = 0.90). Dichotomous results were also outstanding with sensitivity to detect moderate/severe AS of 91% and specificity of 94%. Conclusions: AI can identify AS from 3 B-mode views and characterize AS severity with accuracy highly congruent to an expert panel using full Doppler data. This may allow AS to be detected in low-resource and screening settings. Further assessment with a larger hold-out test set is planned.
Abstract 14358: A Rare Case of Refractory Ventricular Arrhythmias Caused by Subacute Aortic Root Thrombosis Following Left Ventricular Assist Device
Authors: Rupinder Buttar, Amr A Salama, Gurveer Khosa, Ido Goldenberg, bipul baibhav, Abrar H Shah
Journal: Circulation (2022)

Introduction: Aortic Root thrombus (ART) is relatively uncommon complication following left ventricular assist device (LVAD) therapy with significant morbidity and mortality. Case: A 51-year-old male with coronary artery disease with CABG (LIMA to LAD and sequential SVG) presented with acute cardiogenic shock. EKG showed right bundle branch block with diffuse T wave inversions. Coronary angiogram showed severe three vessel disease with occlusion of all vein grafts except LIMA-LAD. Patient subsequently underwent LVAD with HM3 implant placement as a destination therapy. He was started on warfarin with heparin drip as a bridge. Post op course was complicated by recurrent VF storm. Patient was started on amiodarone and lidocaine. A transthoracic echocardiogram showed LVAD inflow cannula in place and aortic valve was noted to be closed with every beat. HM3 speed was decreased to 5500 rpm. Patient continued to have recurrent episodes of VF, refractory to cardioversion and anti-arrhythmic agents. CT angiogram showed aortic root filling defect consistent with thrombosis extending from the leaflets towards the Sino tubular junction, along the left coronary cusp leaflets. Patient eventually required VT ablation for refractory ventricular arrhythmia. Patient underwent median sternotomy for surgical removal of aortic root thrombus which showed parts of the thrombus intimately connected to the aortic root wall including the left main and right coronary ostia. Post op patient was continued on systematic anticoagulation with noted clinical improvement. Conclusion: ART after LVAD placement is a rare complication and can be associated with myocardial infarction and thromboembolic events. It can compromise coronary perfusion and result in ischemic ventricular arrhythmias as seen in our case. Management includes surgical removal of the pump or orthoptic heart transplantation. VT ablation should be considered if no ischemic culprit identified
Abstract 14375: Guideline Directed Medical Therapy After Peripheral Vascular Intervention and Association With Long-Term Outcomes at an Academic Health System
Authors: Jiun-Ruey Hu, Kim G Smolderen, Jeremy A Provance, Gaelle Romain, Andreas Baumbach, Eric J Velazquez, Francine Lorusso, Keith Churchwell, Wade L Schulz, Lindsey Scierka, Carlos Mena-Hurtado
Journal: Circulation (2022)

Introduction: Guideline-recommended medical therapy (GDMT) for cardiovascular risk reduction remains sub-optimally prescribed in patients with peripheral artery disease (PAD). To begin addressing this issue, it is key as a health system to be able to monitor electronic health record (EHR)-based real-world data to assess GDMT usage rates and its association with long-term mortality and amputation. Methods: We included all patients with PAD who underwent peripheral vascular interventions (PVI) across the Yale New Haven Health System in 2016-2022. GDMT at PVI discharge was defined as having all 3 of: angiotensin converting enzyme inhibitor/angiotensin receptor blocker (if hypertensive), antiplatelet, and statin. Propensity scores were calculated based on age, sex, race, ethnicity, and Elixhauser comorbidities. Inverse probability weighted Cox regression models with a random effect for site and provider were constructed to evaluate the relationship between GDMT and 2-year mortality and major amputation. Results: A total of 3,741 patients with PAD underwent PVI. The average age was 72.3 (± 12.9) years, and 39% were female. GDMT rates at PVI discharge ranged from 24% to 40% during the study period. Lack of GDMT at discharge had a statistically insignificant association 2-year mortality risk (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.98-1.50, p=0.07; figure top) and a significant positive association with 2-year major amputation risk (HR: 2.73, 95% CI:1.51-4.94, p&lt;0.001; figure bottom). Conclusions: This study leveraged system-wide EHR data to study GDMT use and its association with mortality and major amputation, which may serve as a metric for quality of PAD care.
Abstract 14142: Trends in Cardiovascular Services and Procedure Volumes Across Different Phases of the COVID-19 Pandemic: An Analysis of 2019- 2022
Authors: Aaysha Cader, Ishmum Z Chowdhury
Journal: Circulation (2022)

Introduction: The COVID-19 pandemic's impact on cardiovascular (CV) services globally was variable, with little data on trends from South Asia. Hypothesis: We hypothesized changes in trends of CV services delivery and procedure volumes from 2019-2022. We aimed to assess the pandemic's impact at a Bangladesh tertiary cardiac centre. Methods: Data on patient visits, admissions, procedures and catheterization volumes were collected from January 2019 to February 2022. Differences for each month of the preceding year were expressed as a percentage (%Δ). Trends (2019 to 2022) were graphically depicted via line diagrams. Results: Significant reductions of cardiology services occurred in 2020, especially ER visits (Δ-59.5%; p&lt;0.001). Patient and procedure volumes reached almost pre-pandemic levels by Q1 of 2021. A decline of admissions and procedures was seen in March-April 2021 as compared with 2020, coinciding with the Delta variant. By Q4 of 2021, patient visits, outpatient procedures and catheterization volumes had reached near pre-pandemic levels again. During the Omicron surge (Q1 of 2022), a small decline in outpatient visits (Δ-10.9%) and procedures (Δ-6.83%) was seen. However, in-patient admissions (Δ4.39%) and catheterization procedures (Δ5.7%) showed a rise in February 2022, compared to January, with ER visits showing the steepest rise (Δ 41.9%). Although ER visits remained relatively blunted post-pandemic (2020-2021), this trend was not reflected in outpatient visits/procedures, admissions and catheterization procedures, which all increased to pre-pandemic levels by end 2021. Conclusion: Two years on from the pandemic, cardiology services and cath lab volumes have reached almost pre-pandemic levels in 2022, except for ER visits which remained low, albeit gradually rising. Procedure volumes reduced during the Delta variant, but not during the Omicron surge, a positive indication of the learning and adaptability of healthcare system to surges.
Abstract 14256: Dual-Targeted NIRF Molecular Imaging Combined With Intravascular OCT for Inflammatory Micro-Calcification in the High-Risk Plaque
Authors: Dong Oh Kang, Yong Geun Lim, Yeon Hoon Kim, Ryeong Hyun Kim, Hyun Jung Kim, Hyeong Soo Nam, Joon Woo Song, Jin Hyuk Kim, Ye Hee Park, Wang-Yuhl Oh, Kyeongsoon Park, Hongki Yoo, Jin W Kim
Journal: Circulation (2022)

Background/Objectives: Micro-calcification is a major target for high-risk plaque but the mechanistic linkage with macrophage-driven inflammation remains questionable. To address this issue, we newly innovated dual-targeted multimodal imaging strategy for calcifying inflammatory activity by integration of intravascular OCT with near-infrared fluorescence (NIRF) molecular imaging. Methods/Results: We fully integrated dual-targeted NIRF molecular imaging with intravascular OCT. Novel NIRF emitting probe targeting micro-calcification was fabricated by chemically coupling alendronate and Cy5.5 to the ends of azide-PEG-NHS ester (Al-Cy5.5). Based on whole body biodistribution, OCT/dual-NIRF in vivo imaging of rabbit aortoiliac atheroma was acquired 48 hrs and 72 hrs after intravenous injection of Al-Cy5.5 (5.0 mg/kg) and macrophage mannose receptor targeted Cy7-emitting probe (7.5 mg/kg), respectively. NIRF signals of Cy5.5 and Cy7 were highly enhanced at the area of micro-calcification and macrophage accumulation within the plaque (Figure) (p&lt;0.01). Fluorescence microscopy and immunostainings from the corresponding sections well corroborated the in vivo findings and concomitantly elevated dual-NIRF signals indicated the presence of calcifying inflammatory activity in atheroma. Intriguingly, osteogenic activity (TRAP stain) was closely interconnected with macrophages in superficial micro-calcification rather inner dense calcification (p&lt;0.01). Conclusions: Our intravascular OCT/dual-NIRF imaging was feasible to simultaneously visualize micro-calcification, osteogenic activity and macrophages in the coronary-sized atheroma. This novel imaging strategy is expected to expand our pathophysiologic insight for the biological behavior of calcifying inflammatory activity existing on the superficial fibrous cap portion of high-risk plaques.
Abstract 144: Impact Of Gender On Outcomes In The Extracorporeal Cardiopulmonary Resuscitation Population For Out-of-hospital Cardiac Arrest
Authors: Johnny Chahine, Marinos Kosmopoulos, Ganesh Raveendran, Demetris Yannopoulos, Jason Bartos
Journal: Circulation (2022)

Introduction: Extracorporeal Cardiopulmonary Resuscitation ( ECPR) is associated with improved neurologically favorable survival for refractory ventricular tachycardia/ventricular fibrillation (VT/VF) arrests. Women are known to have less coronary artery disease, and it is unknown if the lack of a reversible cause would be associated with worse outcomes after ECPR. Hypothesis: We hypothesize that female gender may be associated with worse outcomes after ECPR. Methods: Patients who presented for refractory VT/VF arrest between 2015 and 2021 were included. The primary outcomes included overall survival at 36 months and neurologically favorable survival on discharge (Cerebral Performance Categories scales of 1 or 2). Secondary outcomes included cardiopulmonary resuscitation (CPR) time, median lactate level on presentation, and bystander CPR. Results: Out of 357 patients who presented for out-of-hospital cardiac arrest, 68 patients (19%) were female. The median age for females was 57 years (IQR 57-52) and for males was 59 years (IQR 50-66). Women were more likely to receive ECPR and not to be excluded (5.9% of women were excluded vs. 14.9%, p=0.048) and were less likely to have obstructive coronary disease on coronary angiogram at presentation (39.5% vs. 62.9%, p=0.005). There was no difference in neurologically favorable survival based on gender (39.1% in women vs. 33.7%, p=0.42) nor 36 months survival (p= 0.58, figure). There was also no difference in median CPR time (62 minutes (IQR 51-76) in women vs. 59 minutes (IQR 45-70), p=0.16), median lactate levels (11.5 mmol/L (IQR 8-14.8) in women vs. 11.6 mmol/L (IQR 8.7-14.7), p=0.95), and in receiving bystander CPR (65.6% in women vs. 70.1%, p=0.49). Conclusion: There is no difference in neurologically favorable survival or overall survival based on gender in ECPR patients who had an out-of-hospital cardiac arrest, despite the difference in the prevalence of obstructive coronary artery disease on presentation.
Abstract 14050: A Giant Free-Floating Ball Thrombus or a Tiny Fibroelastoma: Which Causes Multiple Strokes?
Authors: Swiri Konje, Yeraz Khachatoorian, Arpanjeet Kaur, Nirupama Krishnamurthi, Soheila Talebi
Journal: Circulation (2022)

Background: Left atrial (LA) thrombus is not rare in patients with mitral valve stenosis, but in patients with nonvalvular atrial fibrillation on anticoagulation, the formation of a "ball thrombus" in the LA is uncommon. Case: A 73-year-old man with nonvalvular atrial fibrillation on eliquis presented with frequent syncope and slurred speech. .The appearance of the infarcts on brain MRI and involvement of different vascular territories suggests embolic phenomena as the cause. On transthoracic echo a large, highly mobile echo density in the left atrium was noted. Transesophageal echo revealed smoke in the left atrium and the left atrial appendage. A large round mobile echo density mass measuring 4.7 cm X 3.6 cm was seen in left atrium with no attachment to left atrium. A mobile round density measuring 0.7x0.7 cm was seen on the right coronary cusp. Absence of perfusion, no enhancement, and high signal intensity on T1 and T2 weighted images on cardiac MRI was suggestive organized clot in left atrium. Decision-making: Both masses were removed successfully. Pathology confirmed a large intact spherical organized clot from the LA and a small fibroelastoma attached to the aortic leaflet. Conclusion: This was a rare case of giant round-shaped left atrium thrombus, which occurred in a patient with nonvalvular atrial fibrillation on anticoagulation. An aortic fibroelastoma was also discovered by transesophegeal echo as another potential cause of stroke. The left atrial thrombus is thought to have developed from a small mural thrombus caused by prolonged blood stagnation, which gets rounded by the sculpting impact of multiple complex encounters with the atrial wall. This may then detach from the LAA and form a floating "ball thrombus.
Abstract 14366: Young, Healthy Female With Myocarditis and Cardiogenic Shock After Mild COVID-19 Infection
Authors: Sukhpreet Kaur, Paul Montana, Miguel Martillo, Luanda Grazette
Journal: Circulation (2022)

Background: We present a case of a young female with no pre-existent conditions, who presented to the hospital one month after a mild COVID-19 infection with severe myocarditis complicated by cardiogenic shock. Case: A 40-year-old female with no prior medical history and a regular, vigorous exercise program developed a mild COVID-19 infection with symptoms of mild fatigue, myalgias, chills, fever, and loss of taste, which resolved within a week. A month later, she presented to the hospital with exertional dyspnea, weakness, chest pressure, abdominal pain, and fatigue. A transthoracic echocardiogram revealed a left ventricular ejection fraction of 15% with a severely dilated left ventricle, global hypokinesis and severe mitral regurgitation. Right heart catheterization demonstrated cardiogenic shock with a cardiac index of 1.4 liters per minute by Fick equation, and she was admitted to the cardiac intensive care unit. Cardiac magnetic resonance revealed subepicardial delayed enhancement along the lateral and inferolateral walls and elevated T1 mapping consistent with myocarditis. A right ventricle biopsy revealed myocyte hypertrophy and patchy interstitial fibrosis without evidence of inflammatory tissue. She was diuresed, supported with inotropic therapy, and empirically treated with high doses of glucocorticoids. She clinically improved with weaning of inotropes and was discharged in stable condition on goal-directed medical therapy after 2.5 weeks. Conclusion: This patient represents a case of severe cardiogenic shock, after initial infection and in the absence of previously identified risk factors for development of COVID myocarditis. The absence of inflammatory tissue on pathology raises questions regarding the centrality of inflammatory processes in COVID-19-related myocardial injury leading to “long COVID” syndrome. These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19.
Abstract 14351: Prognostic Impact of a Novel Objective Assessment System for Frailty in Patients Who Undergo Transcatheter Aortic Valve Implantation
Authors: Hiroto Suzuyama, eiji horio, Eiji Taguchi, Yoko Horibata, Masahiro Yamada, Yutaka Konami, Toshiharu Sassa, Ichiro Ideta, Tomohiro Sakamoto
Journal: Circulation (2022)

Background: Preprocedural assessment of frailty is often used to predict prognosis following transcatheter aortic valve implantation (TAVI). We introduced a novel scoring system, the Saiseikai Frailty Score (SFS), which contains objective indices of physical and mental ability, vitality, nutrition status and comorbidity. Methods and Results Consecutive 431 patients who underwent TAVI were prospectively enrolled. The SFS consists of 7 items; gait speed, grip strength, physical activity, body weight, fatigability, cognitive function and serum albumin levels, and the sum of abnormal items is presented as the SFS. SFS 0-1 are defined as low frailty (LF), 2-3 as intermediate frailty (IF) and 4-7 as high frailty (HF). Prognosis up to 1 year after the procedure and landmark analysis after 1yr were prospectively evaluated according to the frailty (median follow-up period 951 days). Of the 431 patients (age 85.0±4.9yrs [mean±SD], male 29.5%), 116 patients (26.9%) were categorized as LF, 197 (45.7%) as IF and 118 (27.4%) as HF. The cumulative 1-year mortality was significantly higher in the HF group than the other 2 groups (p=0.0038, log-rank test). Post 1-year landmark analysis revealed that only the LF had better prognosis than the other 2 groups (p=0.0013). The modified SFS with information of malignancy, lung and kidney function (LF 0-1, IF 2-3 and HF 4-11) clearly stratify the 3 groups in both the short- and long-term mortality (p=0.0006 and p&amp;lt;0.0001). Conclusions: The SFS enabled sophisticated and objective stratification of prognosis after TAVI. This novel frailty assessment system will be useful to determine the precise indication for TAVI.
Abstract 14335: Vascular Complications and Outcomes Following Transcatheter Aortic Valve Replacement in Patients on Chronic Steroids Therapy. A Meta-Analysis
Authors: Song Peng Ang, Tong Hong Chia, Vikash Jaiswal, David Song, Jia Ee Chia
Journal: Circulation (2022)

Introduction: Chronic steroids therapy was reportedly linked to increased vascular complications (VC) following invasive vascular procedures. However, its association with VC after transcatheter aortic valve replacement (TAVR) remained uncertain, with conflicting results being reported. We aimed to compare the rate of vascular complications and outcomes between patients with and without chronic steroid use after TAVR. Methods: We conducted a comprehensive literature search in PubMed, Embase and Cochrane databases for relevant studies. Endpoints were described according to Valve Academic Research Consortium-2 definitions and were assessed within 30 days of TAVR. Effect sizes were pooled using the DerSimonian and Laird random-effects model as risk ratio (RR) with 95% confidence intervals (CI). Results: 5 studies with 6136 patients undergoing TAVR (328 steroids, 5808 non-steroids) were included in the analysis. Patients on chronic steroids were younger (mean age 80.2 vs 82.3 years) and were more likely to be female (56% vs 54%). Patients on chronic steroids had a higher risk of major vascular complications (RR 2.32, 95% CI 1.73-3.11, p&lt;0.001), major bleeding (RR 1.61, 95% CI 1.27-2.05, p&lt;0.001) and aortic annulus rupture (RR 4.66, 95% CI 1.67-13.01, p&lt;0.001). There was no significant difference in terms of minor vascular complications (RR 1.43, 95% CI 1.00-2.04, p=0.05), in-hospital mortality (RR 1.86, 95% CI 0.74-4.70, p=0.19) and 30-day mortality (RR 1.14, 95% CI 0.53-2.46, p=0.74) between both groups. Conclusion: Chronic steroid therapy is associated with increased rate of major VCs, major bleeding and aortic annulus rupture following TAVR. Further randomized controlled trials were encouraged to confirm these findings.
Abstract 14153: The Effect of Gender on Atrial Fibrillation Ablation Outcomes Using a Propensity Score Matched Analysis
Authors: Chad Gier, Faisal Aslam, Mohammed Al-Sadawi, Hina Ijaz, Mahmoud Alsaiqali, Ibrahim Almasry, ABHIJEET SINGH, Eric J Rashba, Roger Fan
Journal: Circulation (2022)

Introduction: Previous studies have shown that woman with atrial fibrillation (AF) have increased non-pulmonary vein (PV) triggers which requires additional substrate modification during AF ablation. However, there remains an incomplete understanding of the impact of gender on AF ablation strategies and outcomes. Methods: At a single tertiary care center between January 2013 and July 2021, we analyzed 1576 AF ablations in 1412 patients, of whom 33% were female. Patients were followed for at least 6 months (mean 34 months) to detect AF recurrence, complications, and emergency room visits/hospitalizations. The effects of gender on AF clinical characteristics, AF recurrence, procedural approach and complications were assessed by multivariate logistic regression analysis using propensity score matching. Results: Of 1412 patients, mean age was 64 and mean BMI was 31 kg/m2. 77% underwent de novo ablations, and 27% patients had persistent AF at the time of ablation. The overall rate of AF recurrence was 37%. There was no difference in AF recurrence when stratified by gender (HR 1.15; CI: 0.92-1.43, p &gt;0.05) and age (Fig. 1A &amp; 1B). After propensity score matching gender 1:1 (criteria: age, type of AF, HTN, DM, and BMI, n = 888 patients), there was no difference in AF recurrence (Fig. 1C) or procedure related complications. Additional substrate modification was associated with persistent AF (OR 2.99; CI: 1.9-4.69, p &lt;0.05) or age greater than 70 years (OR 1.03; CI: 1.02-1.05, p &lt;0.05) with no difference based on gender. During ablation, first pass PV isolation was more likely achieved in males (OR 0.7; CI: 0.53-0.93, p &lt;0.05) and patients with BMI &lt; 30 kg/m2. There was no significant difference in the rate of PV reconnection during redo ablations between genders (OR 1.05; CI: 0.71-1.55, p &gt;0.05). Conclusions: Despite a lower rate of first-pass PV isolation in female patients, there is no difference in overall safety or efficacy outcomes between genders following AF ablation.